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PubMed1999

Determinants of neonatal mortality.

OBJECTIVES: To identify the common causes and contributory factors for high neonatal mortality in Pakistan and propose effective strategies to safeguard against it. METHODS: This retrospective study was carried out in Neonatal Unit (NNU) of Rawalpindi General Hospital (RGH) from January 1995 to December 1996. Relevant prenatal information obtained from referral forms, admission files or attendants was recorded on a proforma at the time of death of a newborn. This included obstetric and medical management of the mother, neonatal resuscitation and care, birth weight (wt) and gestational age. Cause of death was based on available clinical and laboratory data. RESULTS: During the study period, there were 3005 admissions and 268 deaths, resulting in 9% neonatal mortality. Eighty-eight percent of this mortality was due to early neonatal deaths. More than 50% of deaths were unavoidable due to their critical condition at admission and occurred within first 24 hours of hospitalization. Neonatal infections and birth asphyxia were two major causes of neonatal mortality (37% and 31% respectively), followed by idiopathic respiratory distress syndromes (IRDS), Meconium aspiration syndrome (MAS) and congenital malformations. Sixty-eight percent of mortality was contributed by low birth weight (LBW), 74% of them being preterm suggesting high mortality among LBW-preterm infants. Other less common contributory factors were maternal medical disease, complicated deliveries and multiple gestation. CONCLUSION: These causes and contributory factors of neonatal mortality reflect poor prenatal health services in this country. Hence there is a need for coordinated efforts to organise and regionalize MCH and prenatal health services with the help of a neonatal task force.

Female↗
PubMedDate not supplied

A health program's effect on neonatal mortality in eastern Kentucky.

We examined the impact of an innovative rural health program in central Appalachia on neonatal mortality by comparing improvements in the neonatal mortality rates of the serviced counties to those of the 13 control counties. Using data on all births and neonatal deaths in the study and control counties from 1970 to 1978 (tabulated by mother's county of residence), an expected neonatal mortality rate of each county was calculated by standardizing for the most important risk components: birth weight, sex, and birth multiplicity. An index of medical care effectiveness, the standardized mortality rate (SMR) for the study and control counties was computed by dividing the observed neonatal mortality rate by the expected rate. The SMRs of the study and control counties were then compared using a standard normal test statistic. The results indicated that the SMRs were significantly different in the control and study counties in the preintervention period 1970-1972. In subsequent years the SMRs converged, resulting in nearly equal rates for 1977-1978. The improvement in neonatal mortality in both areas may be due to their improved economic status rather than health care alone.

Child Health Services↗
PubMed1998

Neonatal mortality in the Czech Republic during the transition.

OBJECTIVES: To identify factors underlying the reduction in neonatal mortality in the Czech Republic during the 1990s and to identify scope for further improvements. DESIGN: Examination of trends in birth weight and birth weight specific neonatal mortality in the Czech Republic and comparison with figures from Sweden, which has one of the lowest neonatal mortality rates in Europe. SETTING: The Czech Republic. SUBJECTS: All singleton births occurring in the Czech Republic in 1989-1991 and 1994-1995, with a comparison group of all singleton births in Sweden in 1989-1991. MAIN OUTCOME MEASURES: Neonatal mortality rate. RESULTS: Despite a slight worsening in the birth weight distribution, the neonatal mortality rate in the Czech Republic fell from 5.6 to 3.8 per thousand live births. This was due to an improvement in the survival of infants at all birth weights but especially amongst the lightest. Eighty percent of the overall improvement was due to greater survival among those under 2500 g. Comparison with Swedish birth weight specific rates indicates that, for the country as a whole, only small additional gains are likely as a result of improved survival at a given birth weight but, instead, a reduction in the proportion of low birth weight babies would have a much greater effect. Regional analysis indicates that the improvements have been much greater in Prague than in the rest of the country. CONCLUSIONS: An effective strategy to reduce neonatal mortality in the Czech Republic should have two elements. The first is to address the socio-economic determinants of low birth weight. The second is to reduce regional inequalities in the quality of neonatal care. This should, however, be supplemented by more detailed investigation to identify specific amenable factors.

Birth Weight↗
PubMedDate not supplied

Racial differences in birthweight-specific neonatal mortality in Alaska: 1987-1996.

OBJECTIVES: This study compared the neonatal mortality in the Alaska Native and non-native (primarily white) population in Alaska for a 10-year period (1987-1996). METHODS: Natality, mortality, and cause of death data were obtained from the State of Alaska's Bureau of Vital Statistics (BVS). Birthweight-specific and preventable birthweight-specific mortality were analyzed for babies < 1500 grams, 1500-2499 grams, and > or = 2500 grams birthweight. RESULTS: The low birthweight (LBW) and very low birthweight (VLBW) rates were similar for the Alaska Native and non-native populations. The neonatal mortality rate for the Alaska Native population was higher than for the non-native population (6.4 per 1,000 live births for Alaska Native vs. 4.1 for non-native for 1987-1991; 5.5 for Alaska Native vs. 3.5 for non-native for 1992-1996). Birthweight-specific mortality was higher in the Alaska Native population for all birthweight groups. The exclusion of non-preventable conditions accentuated the differences in mortality rates between the Alaska Native and non-native population for infants < 2500 grams birthweight. CONCLUSION: The higher neonatal mortality in the Alaska Native population is associated with a higher overall and preventable birthweight-specific neonatal mortality. The differences are therefore likely to reflect differences in access to and quality of perinatal care.

Alaska↗
PubMed1986

[Neonatal mortality and birth weight. Which strategy for the future?].

In this study the authors analysed the neonatal mortality rates in Belgium in 1981 and 1982. Newborns were grouped into four categories according to their birth weight: 500-1,499 gr (Cat. A), 1,500-2,499 gr (Cat B), 2,500-3,499 gr (Cat C), 3,500 gr or more (Cat D). The distribution of neonatal deaths in those four categories was 33.2% in category A, 29% in category B, 27.3% in category C and 10% in category D. A specific strategy to lower neonatal mortality in each category could be worked out. The authors analysed what priority should be given to each category according to the data found in the literature concerning the following criteria: effectiveness, cost and doing the least damages. They concluded that the present focus on category A, is over done and should not be the strategy to be used at present. The higher neonatal mortality of newborns of category C (2,500-3,499 gr) as compared with the neonatal mortality in category D (3,500 gr and more) is generally underestimated and underanalysed. Reducing this extra mortality could result in lowering Belgium neonatal mortality by 12%. The organisation and accessibility of obstetric care seem to be linked to this higher mortality. In their conclusions the authors suggest other studies and short-term objectives that should be considered in order to lead to a continued lowering in neonatal mortality.

Belgium↗
PubMed1996

Birth weight associated with lowest neonatal mortality: infants of adolescent and adult mothers.

OBJECTIVE: We tested the hypothesis that survival is highest for infants born in the same weight range whether mothers are adolescent or adult, comparing the weights at which infants of these mothers achieve lowest neonatal mortality. METHODS: The relationship between birth weight and neonatal mortality was studied in births to 16.4 million women using the National Center for Health Statistics 1983-1987 national linked birth/infant death data sets. Neonatal mortality rates were calculated for 500 g birth weight categories. Births for maternal ages < or = 15 years, 16 years, and 17 to 18 years were compared with births to adults 19 to 34 years of age, whites and blacks considered separately. The birth weight categories associated with minimum neonatal mortality and the weight range corresponding with greatest survival were determined for each age and racial group. RESULTS: Minimum neonatal mortality rates occurred at the same birth weights (3500 to 4499 g white and 3000 to 3999 g black) whether mothers of the infants were adolescents or adults. The most favorable range of birth weight, in which survival was greatest, commenced at 3000 g for all mothers, terminating at 3999 g for most black adolescents and black adults, 4499 g for most white adolescents, and 4999 g for white adults. Of infants born to mothers < or = 16 years old, 33% were lighter and 1.5% were heavier than the favorable birth weight range. CONCLUSION: The birth weight categories with minimum neonatal mortality and the birth weight range in which neonatal survival was greatest were comparable for infants of adolescents and adults. Lower birth weights, occurring more frequently in births to teenage mothers, were associated with higher neonatal mortality. Assisting adolescent mothers to bear infants with birth weights in the range corresponding with low neonatal mortality is an appropriate goal of clinical management.

Adolescent↗
PubMedDate not supplied

[Comparison of stillbirth and neonatal mortality in two Italian regions: Lombardia and Campania].

OBJECTIVE: To compare fetal and neonatal mortality in two Italian regions, characterized by different socio-economic factors and health care organisations, and to study the main maternal and fetal determinants of mortality. DESIGN: Cohort study. Distributions of births in 1995-1996 by birthweight and gestational age are described and stillbirth, perinatal and neonatal mortality are analysed and compared. The determinants of mortality (birthweight, gestational age, sociodemographic maternal characteristics and type of delivery) have been analysed using logistic regression models. SETTING: Two Italian regions with the highest number of births, Lombardia and Campania. The first represents the industrialized northern Italy, the second the relatively poorly developed southern Italy. PARTICIPANTS: The analysis concerns 300,697 births, 156,436 of which in Lombardia and 144,261 in Campania. MAIN OUTCOME MEASURES: Stillbirth, perinatal and neonatal mortality rates. RESULTS: The percentage of low birthweight (<2,500 grams) is the same in both regions, that is, 5.2%. The percentage of preterm births is higher in Lombardia than in Campania (5.5% vs 3.9%). Stillbirth, perinatal and neonatal mortality rates are lower in Lombardia than in Campania, that is: 3.6 per thousand and 4.2 per thousand; 5.8 per thousand and 7.6 per thousand; 2.9 per thousand and 4.4 per thousand respectively. CONCLUSION: The comparison between the two regions highlights the different role played by the various main determinants. In particular, the gestational age seems to be more important in Campania than in Lombardia, as it is for the neonatal mortality The analysis provides us with some useful elements strictly related to the delivery characterisitcs and consequently to the kind of health care organisation to explain mortality differences between the two regions.

Cohort Studies↗
PubMed2005

[Obstetric delivery and risk of neonatal mortality in Goiânia in 2000, Brazil].

OBJECTIVE: To determine factors associated to vaginal delivery and increased neonatal mortality in cohort studies of newborns. METHODS: A retrospective cohort study was carried out using linkage data from the Information System on Live Births and Mortality Data System database, which included all newborns in Goiânia for the year 2000. A stratified analysis of delivery routes and maternity hospitals by risk factors of neonatal mortality was conducted through the calculation of relative risk at a 5% significance level. Statistical analyses were carried out using the Chi-square test at a 5% significance level. RESULTS: Vaginal deliveries were more commonly seen than cesarean sections in situations where there was an increased risk of neonatal mortality. Public hospitals, where vaginal deliveries predominated, were sought by the majority of those pregnant women with an increased risk of neonatal mortality. Private hospitals, not affiliated to the public-funded Brazilian Healthcare System (SUS) and where the incidence of cesarean section was as high as 84.9%, opted for vaginal delivery in situations of greater risk, such as extreme prematurity and very-low-birth-weight infants. CONCLUSIONS: The association between vaginal delivery and increase neonatal mortality resulted from a selection bias due to the distribution of pregnant women in the hospital network. In addition, this selection bias also resulted from an almost universal preference for cesarean sections in low-risk pregnancies as opposed to vaginal delivery for pregnancies with an increased risk of neonatal mortality.

Brazil↗